Innovation in Heart Care Means a Replacement for the Surgeon’s Knife

In this Monday, March 11, 2013 photo, Atlanta cardiologist Dr. Spencer King demonstrates how a catheter is used to repair a diseased heart valve, at an American College of Cardiology conference in San Francisco. Many problems that used to require open-heart surgery now can be treated with minimally invasive procedures. (AP Photo/Jeff Chiu)AP2013

Heart care is in the midst of a transformation.

Many cardiology problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube.

Thanks to the introduction of new tiny tools and devices, now some patients are getting repairs for valves, irregular heartbeats, holes in the heart and other defects without major surgery.

While once used just to unclog arteries and correct less common heart rhythm problems, these minimal procedures are now also being tested as ways to treat high blood pressure.

All these methods rely on catheters — hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes in blood vessels.

"This is the replacement for the surgeon's knife. Instead of opening the chest, we're able to put catheters in through the leg, sometimes through the arm," said Dr. Spencer King of St. Joseph's Heart and Vascular Institute in Atlanta. He is former president of the American College of Cardiology. Its conference earlier this month featured research on these novel devices.

"Many patients after having this kind of procedure in a day or two can go home" rather than staying in the hospital while a big wound heals, he said. It may lead to cheaper treatment, although the initial cost of the novel devices often offsets the savings from shorter hospital stays.

Not everyone can have catheter treatment, and some promising devices have hit snags in testing. Others on the market now are so new that it will take several years to see if their results last as long as the benefits from surgery do.

But already, these procedures have allowed many people too old or frail for an operation to get help for problems that otherwise would likely kill them.

"You can do these on 90-year-old patients," King said.

These methods also offer an option for people who cannot tolerate long-term use of blood thinners or other drugs to manage their conditions, or who don't get enough help from these medicines and are getting worse.

"It's opened up a whole new field," said Dr. Hadley Wilson, cardiology chief at Carolinas HealthCare System in Charlotte. "We can hopefully treat more patients more definitively, with better results."

For patients, this is crucial: Make sure you are evaluated by a "heart team" that includes a surgeon as well as other specialists who do less invasive treatments. Many patients now get whatever treatment is offered by whatever specialist they are sent to, and those specialists sometimes are rivals.

"We want to get away from that" and do whatever is best for the patient, said Dr. Timothy Gardner, a surgeon at Christiana Care Health System in Newark, Del., and an American Heart Association spokesman. "There shouldn't be a rivalry in the field."